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121 Cards in this Set
- Front
- Back
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cartilege present in what areas of respiratory tree
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trachea and bronchi
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conducting zone goes down to what level, what component contained in walls that is not present in respiratory zone
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terminal bronchioles and above (anatomic dead space)
smooth muscle cells |
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what is epithelium of trachea, bronchi, bronchioles?
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pseudostratified ciliated columnar epithelium
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are goblet cells in epithelium of respiratory tree and if so how far down?
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YES!
extend down trachea, but stop at bronchi. |
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what cells proliferate during lung damage
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type 2 pneumocytes (can replicate and replace type 1 pneumocytes)
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Clara cell fxn (3), structure
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columnar with granules
-secrete a component of surfactant (type 2 pneumocytes secrete the majority of parts of surfactant) -degrade toxins -act as reserve cells |
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what ratio indicates mature fetal lung tissue
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lecithin/sphingomyelin ratio >2
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lamellar bodies found on EM of what type of lung cell?
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type 2 pneumocytes
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lung borders:
mid clavicular mid axillary paravertebral |
mid clavicular: 7th rib
mid axillary: upper border of 10th rib on right, lower border of 10th rib on left paravertebral: 12th rib |
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what is main factor changing airway resistance (part of airway)
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medium sized bronchi
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bronchopulmonary segment:
each has what part of respiratory tree where do arteries, veins, and lymphatics run? |
each segment has a tertiary (segmental) bronchus
2 arteries run with the bronchus (pulmonary and bronchial), veins and lymphatics drain along borders |
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does pulmonary arterial pressure vary greatly throughout cardiac cycle?
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no, elastic nature of walls keeps pressure pretty constant
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lingula on which side
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left side (has 2 lobes and lingula)
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pulmonary artery relation to lung hilas one each side
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RALS
Right- anterior to lung hilas Left - superior to lung hilas |
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if inhale peanut upright, probably goes to?
if laying down? |
upright- inferior portion of right inferior lobe
supine- superior portion of right inferior lobe |
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at what spinal level does each structure perforate the diaphragm?
aorta IVC thoracic duct saphenous vein esophagus vagus nerve |
T8 - IVC
T10 - esophagus, vagus nerve T12 - aorta, saphenous vein, thoracic duct |
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3 muscles used in strenuous inspiration
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external intercostals, scalenes, sternocleidomastoid
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4 sets of muscles used in active expiration
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rectus abdominis, external/internal obliques, internal intercostals, transverse abdominis
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dipalmitoyl phosphatidylcholine is
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surfactant
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surfactant effect on:
alveolar surface tension compliance |
decreased surface tension
increases compliance |
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2 enzymes produced in lung that act on bradykinin
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ACE - inactivates bradykinin
Kallikrein - activates bradykinin |
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Functional residual capacity is
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amount of air in lungs after normal tidal volume expiration
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Residual Volume is
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air in lungs left after maximal exhalation (cannot be measured on spirometry)
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Expiratory Reserve Volume is
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the additional amount of air that can be pushed out of lungs after normal Tidal Volume exhalation level
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physiologic dead space:
definition equation what part of lung is greates contributor to physiologic dead space? |
is amount of air in conducting airways that does not participate in gas exchange plus functional dead space in alveoli
physiologic dead space= Tidal volume X (partial pressure CO2 inspired air - partial pressure C02 expired air)/ partial pressure C02 inspired air largest contributor - apex of lungs |
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at what point in Lung volume curve is lung recoil and chest wall expansion in equilibrium?
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FRC (bottom of Tidal volume exhalation)
airway and alveolar pressure are 0. intrapleural pressure is negative |
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compliance equation
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compliance is volume/pressure
slope of lung-chest wall pressure/volume curve |
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what is difference between T and R form of Hemoglobin?
5 factors that cause change? |
T- taut (low 02 affinity)
R- relaxed (high O2 affinity) changes to T form - high Cl-, high temp, low pH, high CO2, 2,3-BPG |
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methemoglobin
what is problem, increased affinity for what and decreased affinity for what? |
oxidation of ferric (Fe2+) iron to Ferrous (Fe3+) iron in heme.
increases affinity to Cyanide decreases affinity for 02 decreases O2 saturation |
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methemoglobinemia is treated with?
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methylene blue
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in cyanide poisoning, why use nitrites?
why use thiosulfate? |
nitrites oxidize heme to methemoglobin which likes to bind cyanide (and decreases substance messing with chytochrome oxidase)
thiosulfate binds cyanide so it can be renally excreted |
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what causes carboxyhemoglobin?
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CO binding to hemoglobin, causing decreased oxygen binding capacity but increased affinity for O2 (so less 02 and less delivered to tissues)
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In 02-hemoglobin dissociation curve, what does right shift mean?
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the affinity of hemoglobin for 02 decreases, so more 02 is delivered to the tissues (decrease pH, increased C02, acid, increased altitude, 2,3-DPG, increased exercise, increased temperature
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does increasing altitude cause right or left shift of 02-hemoglobin dissociation curve?
CO? |
increased altitude - right shift (decreased affinity)
CO - left shift (increased affinity) |
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in pulmonary vasculature, a decrease in PA02 causes
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hypoxic vasoconstriction (to shunt to better ventilated areas).
this is opposite of systemic circulation |
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is normal pulmonary circulation perfusion or diffusion limited?
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perfusion (gas equilibrates early in capillary)
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4 situations that result in diffusion-limited respiration
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emphysema (decreased area)
pulmonary fibrosis (increased thickness) exercise CO |
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is pulmonary artery pressure of 25 mm Hg normal?
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no, at or above 25 is pulmonary HTN
normal is 10-14 mm Hg |
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cause of primary pulmonary HTN
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BMPR2 inactivating mutation (inhibits vascular smooth muscle proliferation
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3 vessel changes seen in pulmonary HTN
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atherosclerosis
medial hypertrophy intimal fibrosis |
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end result of pulmonary HTN
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severe respiratory distress--> cor pulmonale and RV failure (JVD, edema, hepatomegaly), decompensate and die
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6 secondary causes of pulmonary HTN
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COPD
recurrent thromboemboli Left-to-Right shunt sleep apnea high altitude mitral stenosis autoimmune disease |
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how does Left-to-Right shunt cause pulmonary HTN
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increases sheer stress - endothelial injury
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how does sleep apnea or living at a high altitude cause pulmonary HTN
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hypoxic vasoconstriction response in pulmonary vaculature
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how do recurrent thromboemboli cause pulmonary HTN
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decrease cross-sectional area of pulmonary vascular bed
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what is pulmonary vascular resistance equation
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PVR= (pressure in pulmonary artery - pulmonary wedge pressure)/Cardiac Output
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if Hb levels fall, which change?
O2 content O2 saturation Pa02 |
02 content decreases
02 saturationa and partial pressure remain the same |
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what is equation for 02 content
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= (02 binding capacity X 02 saturation %) + dissolved 02
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Alveolar gas equation =
what is normal A-a gradient? |
PA02 = 150- PAC02/0.8
10-15 mmHg |
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three possible causes of increased A-a gradient
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fibrosis (increased diffusion), shunting, v/q mismatch
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what 02 measurement decreases in chronic lung disease
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Pa02 because physiologic shunt decreases 02 extraction ratio
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cardiac output x 02 blood content is
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oxygen delivery to the tissues
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hypoxemia vs hypoxia vs ischemia, difference?
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hypoxemia - decreased Pa02
hypoxia - decreased 02 delivery to tissues ischemia - decreased blood flow to tissues |
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V/Q in apex and base of lung
which has ratio of 3? which has ratio of 0.6? |
apex - 3 (wasted ventilation, increased dead space because alveolar pressure bigger than capillary pressure and bvs collapse)
base - 0.6 (wasted perfusion, more ventilation but greater increase in perfusion so not all blood adequately oxygenated) |
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in what situation does apical V/Q ratio approach 1
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exercise (vasodilation)
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if V/Q mismatch, will high or low V/Q benefit from 02 therapy?
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large V/Q (blood flow obstruction, exposed blood can still get oxygenated)
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where does C02 bind to hemoglobin?
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N terminus of globin, NOT HEME group
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3 forms of C02 in blood
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bicarb (90%)
carbaminohemoglobin (5%) dissolved (5%) |
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in lungs, oxygenation of Hb promotes dissociation of what from Hb
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H+, --> C02 release
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high altitude body changes:
ventilation 2 kidney changes protein concentration change cellular change |
both acute and chronic ventilation
increase Epo, increase bicarb excretion (to compensate for respiratory alkalosis) increase 2,3-BPG increase mitochondria |
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what changes in exercise?
Pa02 PaC02 venous C02 content |
Pa02 and PaC02 same
venous C02 content increased |
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amniotic fluid emboli can lead to
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DIC (especially postpartum)
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test of choice for PE
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CT angiography
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Homan's sign
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dorsiflexion of foot - DVT
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lung changes in obstructive lung disease
RV FVC FEV1/FVC |
RV - increased
FVC - decreased FEV1/FVC - less than 80% |
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wheezes, crackles, cyanosis, early onset hypoxemia and late onset dyspnea
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chronic bronchitis (blue bloater)
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decreased breath sounds, tachycardia, late-onset hypoxemia, early onset dyspnea
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emphysema (pink puffer with barrel-shaped chest)
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emphysema type:
smoking alpha-1 antitrypsin deficiency |
smoking - centriacinar
alpha 1 antitrypsin - panacinar |
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paraseptal emphysema have what association, seen in what population?
what is complication? |
on periphery of lung, frequently have bullae
seen in young healthy males can rupture--> spontaneous pneumothorax |
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emphysema vs chronic bronchitis
which purses lips |
emphysema to maintain airway pressure and prevent airway collapse during expiration
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chronic bronchitis definition
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productive cough for more than 3 consecutive months in 2 years
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shed epithelial mucosal plugs, pulsus paradoxus, smooth muscle hypertrophy seen in what condition
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asthma
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what is a chronic necrotizing infection of the airways
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bronchiectasis
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bronchietasis:
what happens to airways sputum? can develop what? 2 conditions that can cause |
chronically dilated airways with purulent sputum, can get hemoptysis and recurrent infections
can develop aspergillosis CF, Kartagener's |
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4 causes of restrictive lung disease due to poor breathing mechanics (2 diseases, 2 body conditions)
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Polio, Myasthenia Gravis, obesity, scoliosis
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bilateral hilar lymphadenopathy with noncaseating granuloma? increase in what enzyme, and what lab
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Sarcoidosis
increase ACE inc. Ca++ |
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Eosinophilic granuloma is
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Histiocytosis X
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3 drugs that can cause restrictive lung disease
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amiodarone, bleomycin, busulfan
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Goodpasture's, Wegner's granulomatosis, pneumoconioses, hyaline membrane disease cause what type of lung disease?
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restrictive
hyaline membrane disease = Neonatal Repiratory Distress Syndrome |
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Coal Miner's disease
can progress to what two conditions? Affects what lobes? |
cor pulmonale, Caplan's Disease (cough with rheumatoid arthritis symptoms)
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"Eggshell" calcification of Hilar lymph nodes
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silicosis
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what pneumoconiosis found in foundries, mines, sandblasting?
causes what change in lung tissue and what lobes thought to increase susceptibility to what? |
silicosis
fibrosis (from macrophages releasing fibrogenicc factors) in upper lobes increased suceptibility to TB |
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gold-brown fusiform bodies inside macrophages indicate?
what else would be seen, where |
Asbestosis (look like dumbells)
"ivory white" calcified pleural plaques in lower lobes |
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associated with shipbuilding, roofing, plumbing?
increased risk of what 2 malignancies |
asbestosis
bronchogenic carcinoma, mesothelioma |
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theraputic supplementation of 02 in neonates can result in
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retinopathy of prematurity
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surfactant made mostly after what week?
lecithin/sphingomyelin ratio usually below what in neonatal respiratory distress syndrome |
week 35
<1.5 |
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3 risk factors for hyaline membrane disease?
treatment (3) |
Neonatal Repiratory Distress Syndrome
prematurity maternal diabetes cesarean section artificial surfactant thyroxine maternal steroids before birth |
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causes of Adult Respiratory Distress Syndrome causes (9)
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trauma, shock, surgery, acute pancreatitis, sepsis, gastric aspiration, uremia, amniotic fluid embolism
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2 components of ARDS on pathology?
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fluid accumulation in alveoli and hyaline membrane deposition
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3 types of initial damage to alveoli during onset of ARDS
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PMN toxic substance release
oxygen-derived free radicals activation of coagulation cascade |
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obstructive vs central sleep apnea
what hormone increased what electrical change may happen what physical change may happen |
central - no respiratory effort
obstructive - respiratory effort against airway obstruction Epo increased (erythrocytosis) arrhythmias can develop pulmonary HTN can develop (hypoxemic vasoconstriction) |
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In what situation will breath sounds be hyperresonant
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tension pneumothorax
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bronchial obstruction changes:
breath sounds resonance fremitus tracheal deviation |
decreased breath sounds over obstruction
decreased resonance decreased tracheal deviation toward same side as obstruction |
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in what condition with there be increased fremitus
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lobar pneumonia
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Tracheal deviation away from lesion indicates?
toward lesion indicates? |
toward - bronchial obstruction
away - tension pneumothorax |
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Pleural effusion changes:
breath sounds resonance fremitus |
decreased over effusion
resonance = dullness decreased fremitus |
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Lobar pneumonia changes:
breath sounds resonance fremitus |
may have bronchial breath sounds over lobar pneumonia
resonance = dull increased fremitus |
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Tension pneumothorax changes:
breath sounds resonance fremitus tracheal deviation |
breath sounds decrease
hyperresonnance no fremitus trachea deviates away from lesion |
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common lung metastases
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adrenals, brain (epilepsy), bone (pathological fxs), liver (jaundice)
LUNGS borrow legs before adiosing |
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lung complications
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SPHERE
superior vena cava syndrome pancoast tumor horner's syndrome endocrine (paraneoplastic) recurrent laryngeal symptoms (hoarseness) effusions |
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superior vena cava syndrome
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SOB followed by swelling of face and/or arm
bronchogenic carcinoma, thymoma, Burkitt's |
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2 central lung cancers
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squamous cell carcinoma
small cell (oat cell) carcinoma |
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hilar mass arising in bronchus with cavitation is what cancer?
what is histo (2)? |
squamous cell carcinoma
keratin pearls and intercellular bridges linked to smoking, can make PTHrp |
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2 peripheral lung cancers
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adenocarcinoma
large cell carcinoma |
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2 cancers associated with smoking
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small cell and squamous cell
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superior vena cava syndrome
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SOB followed by swelling of face and/or arm
bronchogenic carcinoma, thymoma, Burkitt's |
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2 central lung cancers
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squamous cell carcinoma
small cell (oat cell) carcinoma |
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hilar mass arising in bronchus with cavitation is what cancer?
what is histo (2)? |
squamous cell carcinoma
keratin pearls and intercellular bridges linked to smoking, can make PTHrp |
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2 peripheral lung cancers
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adenocarcinoma
large cell carcinoma |
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2 cancers associated with smoking
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small cell and squamous cell
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lung cancer with hemorrhagic pleural effusions and pleural thickening
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mesothelioma
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Pancoast's tumor
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tumor in apex of lung that affects cervical sympathetic plexus and causes Horner's syndrome
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Lobar pneumonia bug causes (2)
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PhuK lobar pneumonia
strep pneumo, klebsiella |
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Bronchopneumonia bug causes (4)
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Staph aureus, klebsiella (this and lobar), strep pyogenes, H flu
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Intersitial pneumonia bug causes (4)
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mycoplasma pneumoniae, legionella, chlamydia pneumonia, Viruses (RSV, adenovirus)
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type of pneumonia:
acute inflammatory infiltrates from bronchioles into adjacent alveoli, patchy, multiple lobes |
bronchopneumonia
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type of pneumonia:
diffuse patchy inflammation localized to interstitial areas at alveolar walls, multiple lobes |
interstitial pneumonia
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lung abcess
2 common causes 2 common organisms |
causes - obstruction, aspiration of oropharyngeal contents
bugs - staph aureus, anaerobes |
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what is increased in lymphatic pleural effusions
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TGs
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malignancy, collagen vascular disease, trauma produce what type of pleural effusion
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exudate (high protein, due to states that increase vascular permeability)
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can nephrotic syndrome produce transudate or exudate pleural effusion?
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transudate
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